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General NPI Number Information
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NPI Number | 1215561139
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Entity Type | Organization
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Legal Business Name | HEALING AND RENEWAL WELLNESS
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Dates
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Enumeration Date | 02/29/2020
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Last Update Date | 02/29/2020
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Provider Practice Location Address
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Address Line | 464 CHEROKEE AVE SE STE 202
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City | ATLANTA
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State | GA
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Zip | 30312-3260
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Country | US
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Telephone | 678-379-7019
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Fax |
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Provider Business Mailing Address
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Address Line | 138 TYE ST SE APT 1
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City | ATLANTA
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State | GA
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Zip | 30316-1155
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Country | US
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Telephone | 678-471-8090
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | KATELYNN VILLARI
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Credential | LCSW
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Telephone | 678-471-8090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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